C:\Documents and Settings\Barry.CCRC_DOMAIN\Desktop\Private Road Permit Application.doc/elc/12-29-2008
NAME: NAME:ADDRESS: ADDRESS:CITY: STATE: ZIP: CITY: STATE: ZIP:PHONE: FAX: PHONE: FAX:EMAIL ADDRESS: EMAIL ADDRESS:
Applicant agrees to and will adhere to the conditions stipulated on this application, as well as, all specifications listed onthe permit when issued.
Issuance of this permit does not imply consent for use of the land that may be inconsistent with other local, township, county, state and/or federal ordinances and does not negate the need for other such permits.This permit is good for one year from issue date or otherwise stipulated on permit when issued.
Applicant / Contractor Signature Date
Street Number (if known) Street Name on the side.(N, S, E or W)Located of Township(Feet or Miles) (N, S, E or W) (Closest Intersection)
Private Road Name:
New Private Road Approach $233.10Approach Detail Review $126.00Construction Inspection $510.30Temporary Construction Access $ 63.00Standard Specification Book (printed) $ 37.80Standard Specification Book (CD) $ 37.80Other: _______________________________ $_____
Staking of Proposed Access
Stakes three and one half (3 ½) feet above the ground with a noticeable color tip or flagging must be placed on each sideof the proposed access and at either property line for the purpose of determining sight distance. These stakes should be inplace when the access is applied for. Project plans conforming to the Calhoun County Standard Specification Book arealso required.
Are you going to request this private road become a public road upon completion? ______Yes ______No
Access must slope away from the road ½ inch per foot, a minimum of four (4) feet or the width of existingshoulder, whichever is greater.2.
CCRC policy requires culvert installation for driveways/roads countywide.3.
Applicant will provide a detailed drawing of the site showing proposed access and a cross section of the roadway.4.
Thoroughly read the back of this application.
The permit is good for one year from the permit issue date.
Approved by Title Date ______
PRIVATE ROAD PERMIT APPLICATION
13300 15 Mile Road - Marshall, MI 49068Phone (269) 781-9841 (800) 781-5512 - Fax (269) 781-6101www.calhouncrc.net
OFFICE USE ONLY
TownshipPermit NumberDate IssuedExpiration Date